The social science of IUDs

IUDs are the weird form of birth control. We don't really know exactly how they work, for instance. And they've been largely unpopular my entire lifetime—really, ever since a couple of poorly designed IUDs set off a mini-panic in the late 1970s and early 1980s. But IUDs are effective birth control. The ones that you can buy today are safe. And, more importantly, they represent birth control that you don't have to think about, and birth control that is really hard to get wrong.

If you've ever done research on the effectiveness of various methods of birth control, you'll notice that the statistics usually come with a little asterisk. That * represents a concept that few of the people who rely on birth control ever think about—perfect use. Let's use condoms as an example. With perfect use, 2 out of 100 women will get pregnant over the course of a year's worth of condom-protected sex. Without perfect use—maybe you don't use a condom every time, maybe you don't put it on right when you both get naked—the number of accidental pregnancies jumps to 18 out of 100. The same basic problem affects birth control pills, as well. Ladies, did you know you're supposed to take those things at the same time of day every day? That's the kind of use error that can make a difference between 1 out of 100 women getting pregnant in a year, and 9 out of 100 getting pregnant.

In contrast, IUDs represent a fit-it-and-forget-it method of birth control. Which is a big part about why they're up there with outright sterilization as the most effective means of birth control available. Bonus: Depending on which kind you use, you can avoid hormonal side effects. This, experts say, is why IUDs are experiencing something of a resurgence in popularity. In an article at Wired, Jennifer Couzin-Frankel writes that 5.5 percent of American women who use birth control use IUDs. That's up from only 1.3 percent in 1995.

Somewhat unbelievably, no one is quite sure how they work, but the theory goes like this: The human uterus has one overriding purpose, which is to protect and sustain a fetus for nine months. If you stick a poker-chip-sized bit of plastic in there, the body reacts the way it does to any foreign object, releasing white blood cells to chase after the invader. Once those white blood cells are set free in the uterus, they start killing foreign cells with efficient zeal. And sperm, it turns out, are very, very foreign. White blood cells scavenge them mercilessly, preventing pregnancy. In copper- containing IUDs, metal ions dissolving from the device add another layer of spermicidal action.

... Most modern IUDs incorporate copper, which has an assortment of benefits, including increased durability and effectiveness. They’re also free of hormones and can be made cheaply, a boon for women in developing countries. But copper IUDs can cause heavy menstrual bleeding and cramping. The Mirena solves that problem by forgoing the metal for a synthetic version of the hormone progesterone. Here again, the mode of action isn’t completely understood, but researchers suspect that the hormone thickens cervical mucus, which makes it nearly impossible for sperm to swim upstream. It may also thin the uterine lining, rendering it inhospitable to an embryo should fertilization occur. The hormone-based IUD has the opposite side effect of the copper ones: It sometimes leaves women with little uterine lining to shed, so they hardly get any period at all.

... Even though many more doctors are comfortable with the IUD, a generation of doctors didn’t get practice inserting it. And if they don’t know how to put one in, they’re less likely to recommend it as an option. Also, the devices are expensive—the ParaGard costs $500, the Mirena $850. “It’s absolute highway robbery that these companies charge so much,” Espey says. “If you went to Home Depot and got the raw materials for a copper IUD, it would cost less than 5 cents.” And the hormones don’t contribute much more to the cost, she adds. In fact, amortized over years of use—10 for the ParaGard and five for the Mirena—an IUD is far cheaper than birth control pills, which can cost $30 or more a month. But the initial outlay is difficult for some women to manage, and it’s not always covered by insurance.

Hmmm…. I was about to get fitted with the Mirena when I got drastically sick with a bowel bleed — and subsequently I had all kinds of cascading infections, culminating in hydroneuphrosis which erupted after my ureters got grown over with tissue. I have stents in my ureters on both sides, implanted in November 2010 — the weird thing? These have acted exactly as a Mirena. I don’t bleed and certainly haven’t ovulated. Maybe they don’t have to be in the uterus at all — just some kind of foreign object implanted in abdominal tissues and blam, birth control that you don’t have to think about.

careful, girl. there is no reason for a stent in your ureter to act like an iud, i say this as an OB who has cared for plenty of people with different kinds of hardware in various places in the pelvis. there’s plenty of reasons why you might not be getting periods, but don’t assume you aren’t ovulating unless you are checking kits. lots of ladies get pregnant during time periods when their periods aren’t happening. you might be fine, but do use something for birth control if you don’t want to get pregnant!

A friend of mine has had an IUD for years. About a year ago, she began to feel ill and went to the doctor. Turned out, her IUD had somehow moved out of place, and she was pregnant with twins. Possibly a case of a doctor inserting the IUD wrong? Who knows.

This isn’t to say that IUDs aren’t a great form of birth control, but even though they are awfully reliable, things can still go wrong. I guess they, too, deserve a little asterisk.

Same basic experience here. The wife used her IUD for years, a few different types, mostly to avoid hormonal versions of birth control that quite frankly made her absolutely crazy. When we finally decided to make babies out went the IUD and bam, baby.

Really the only downside I saw to the IUD was that I could -feel- it. if I got too excited I’d bump into the bottom of the T and it was rather uncomfortable to do so (ramming the tip of your penis into something sharp and hard very unexpectedly at the height of copulation). This actually limited sex positions as well – certain positions made it almost impossible to enjoy without jabbing the thing repeatedly. There was also some sort of cord attached to it (presumably for future removal) that came a bit further out and was detectable-by-penis-shaft.

It wasn’t the end of the world, but it did lead to a few annoying moments over the years we used the IUD.

Lol. I had the same reaction. The X-ray suggested a wierd piece of shrapnel from an IED in a very painful place, but then I wondered “what does social science have to do with IEDs” and thought maybe it had something to do with readjustment problems after suffering genital wounds. Then it hit me: they are talking about IUDs.

This phenomena also applies to other mammals. It was once a well known practice to push a pebble into the uterus of a camel to prevent the camel from becoming pregnant. I’m not sure if they made any provision for removal, though.

It’s true. When your livelihood depends on the durability of camels, you don’t want to deal with pregnant camels. Consider that the gestation period can be as long as 15 months, then there’s the period when the calf needs care from the mother. That can eat up traveling time and increase costs.

And, lost in the only-sluts-use-birth-control debate (which this thread is NOT participating in, thx!) fertility control can be a medical intervention for other gynecological issues. As noted in the post, the Mirena progesterone-releasing IUD can thin the periodic endometric uterine lining build-up – so the Mirena is often useful for treating endometriosis and uterine fibroid growth, as well as the chronic anemia associated with heavy periods. This means lessening not only discomfort and quality of life issues for women, but also invasive procedures including hysterectomy, and also reduced cancer risk due to the additional progesterone being local rather than systemic. However, many health plans refuse to play for the IUD at all, much less for “off-label” use because… birth control.

Well… one reason for not doing devices like this in your basement is that people tend to get a tad upset if your device causes an infection of the uterus that renders them infertile. Or if it turns out that it just doesn’t work.

The FDA approval process costs are probably a bit too high for your average kickstarter to manage. I’m guessing the ones on the market now are so obscenely expensive because the problems with the past models made getting FDA approval extremely difficult. Not fully understanding how they work certainly doesn’t help the case either.

Yeah, I work with a company that makes devices that have to be FDA compliant and there is a lot of expertise that goes into filing the paperwork and record keeping. If there is a recall, for example, you have to be able to track down every device sold so you can inform the buyer. Also you have to track all the materials in the device. Say the copper in some batches of the IUD had some kind of problem with it, you have to be able to figure out which specific devices were affected. So, the device might cost pennies to manufacture but the company’s cost also has to cover the expertise to get this through the FDA process, and also there would be marketing costs and probably the company hosts some kind of seminar or education effort to teach doctors how to insert them.

Cost is ridiculous. The paraguard costs literally pennies to make at this point, and developing nations buy them from USAID for under a dollar. It is only in the US and western nations that can/will pay that the price is sitll so high. For Mirena, there is only one manufacturer, so brand name is all you get. there is a pre-marketing trial for a generic Mirena going on now, but it will take a couple years for that to be on the market.

I have one and it’s such a relief. After years of trying this pill or that pill, all of which turned me into an absolute lunatic, I got a copper IUD and life is so much more awesome now. Didn’t realize that ParaGard and Mirena were so expensive – thank goodness for Canadian health care….

I have never like IUDs. From a completely selfish standpoint, I never liked the feeling of the IUD’s pull string. It scrapes and just feels unpleasant. No matter how unobtrusive of a kind of a thread it supposedly is for her, I can feel it and don’t like it. Go ahead and joke, but I’m being serious.

One of the things my doctor told me when I was having mine inserted was “if the strings bother your husband, wait a month or two because they often soften up; if it’s still a problem after a couple of months, come back in and we can trim or adjust them.”

If it’s causing you problems, she should tell her doctor and have it adjusted.

Putting a condom on as soon as I get naked hasn’t been a reliably useful approach for me since I turned, oh, 19 or so. Putting it on as soon as I get hard has turned out to work better, except in those occasional instances when I was already hard while still fully dressed. And though plenty of guys bitch about the loss of sensation, I’m not one to complain. Gettin’ laid in a condom is a hell of a lot more fun than not gettin’ laid at all, and is also vastly superior to unwanted pregnancies and infections.

Sorry no kickstart…. Aside from the R&D for design, ballpark $150 million for clinical study of safety and efficacy to satisfy the FDA. Then there will be a manufacturing facility for the FDA to inspect and approve. Once approved, manufactured product must pass release test specifications for the product along with various stability studies.

Lots of employees are needed for qualifying and executing this testing. The cost of materials are almost inconsequential, although much cost will be incurred from the testing of these in-comming raw materials to assure safety of every batch.

Cost shouldn’t be that big of a deal anymore in the US since IUDs are covered under the Affordable Care Act’s requirement that all insurance providers provide contraception free of cost. Since everyone (except the few exempt groups) will be required to have health insurance by 2014, this will be available to everyone for free at that time.

I’ve got and IUD and I LOVE it. Not a single problem. The pill really screwed up my sex drive; IUD does not. Plus I don’t even get a period anymore. It’s like being a kid again. Hello, hassle-free camping!

As I understand it IUDs are the most common form of reversible birth control in the world due to their near universal use in China. My wife used one for years and found it far superior to the alternatives.

IUDs, like most other forms of contraception, are provided free here in the UK on the NHS. On some level I still find it hard to believe that the US healthcare system is really real.

This is good news if you can find a doctor that is willing to put one in.

A few years ago I gave up after calling probably 10 different ob/gyn’s .

There is a slightly higher risk of your body rejecting the IUD and of discomfort if you have not already had a baby. Apparently it also takes a more skilled doctor to insert one correctly in a woman who has not had a baby. Since I don’t have kids I just kept getting turned away because the doctors said it was a liability issue. As one doctor put it, she was sick of putting the effort in if they were just going to have to be taken back out because of problems (which I translate as missing a bullet because if she was that bad at it I didn’t want her anywhere near my lady parts)

I actually had one doctor tell me to my face that I was at breeding age and that I would probably be having a baby soon so she would just put one in then. Imagine my disbelief because I had just explained to her that I didn’t want children ever at that was the primary motivation of wanting the IUD in the first place and then her trying to convince me that I did want children and that I should probably just go ahead and have one to get it out of the way.

I think it also has to do with living in a very religious area of the country where most ob/gyn’s work out of religious hospitals that have their own religious belief driven rules. Nothing like going to a doctor expecting sound medical advice only to learn that no one in the office is educated about the different types of IUD’s and that they would rather talk about why I should want babies instead.

Maybe there are more available educational resources out there for doctors and I can start looking again. More than likely I would have better luck just moving.

According to ACOG, IUDs “are safe for the majority of women, including adolescents and
women who have never had children” and “should be offered as first-line contraceptive methods and encouraged as options for most women.”

I’m nulligravida and nulliparous and absolutely love my copper-T. According to my doctor, my uterus being tipped was more of a challenge relative to inserting the IUD than the fact that I’ve never been pregnant was.

If you ignore the people whose religious objections are about “unnaturalness” or generally about sex, there are still the people who actually care about the fact that the hormone versions of the IUD work by preventing implantation if the spermicidal effects didn’t work. (That’s also an objection to some versions of birth control pills, though I’m a few decades behind on which types are currently most common.) (And yes, preventing implantation isn’t the same as ending a pregnancy, because pregnancy is the mother’s condition, not the child’s – but it’s the same from the pro-life perspective.)

With the IUD, there’s also just a lot of concern among people from my generation about problems for the mother’s health – I’m glad to hear that the newer ones are usually a lot safer, but it’s interesting to see comments from people who’ve had both positive and negative experiences with them.

Just as a cautionary addition to the ‘side effects’ side of things – I chose the copper IUD as a 20-something ‘career’ girl get-it-and-forget-it method because of my aversion to hormones.

A lot changed in the three years I subsequently had it – including a noticeable decline in aspects of my health by the 3rd year.

I had: low sex drive (what the heck! that was not the point!), worsening complexion, hair that wouldn’t grow, weird fatigue, low functioning immune system and increasing irritability to say nothing of all the side effects that actually had something to do with my uterus directly.

Long story short, I developed high copper toxicity levels that my body could not balance after such a sustained amount of exposure to those leaching ‘metal ions’.

Needless to say, it caused a lot of grief and I removed it – not saying this will happen to everyone, but let’s just be honest about the fallout from inserting foreign objects or injecting hormones or whatever else we do to ourselves.

Two things – the men could pick up the slack here, and we could get better at this on the whole if we put some energy behind it.

I have a Mirena that I’ve been suffering with for three years. I hate the random mini periods, constant excess water retention, mood swings, acne, low sex drive and inability to drop those last 10 lbs of baby weight. But you know, YMMV.

I believe birth control should be free for women with (non-religious…) insurance in the US as of this week. So you can get one whenver you get your next period! (The easiest time for insertion, I’m told).

Just had one implanted about 2 months ago. So far so good. But I will say there is another great birth control mechanism contained herein: for us ladies who have never had a baby, you basically have 2-3 contractions as this thing is inserted. What a great way to never, ever want to get pregnant. I’m suddenly very much pro-adoption for myself, should I ever decide I want children.

I’m one of those “lucky” women with astronomical odds against getting pregnant with the Mirena (condoms were used, as well). Luck is one of those things that can be good or bad, I suppose. I loved being period-and-PMS-free for several years, until I started having symptoms that prompted me to look into the possibility of Ovarian Cancer.
I didn’t realize I was pregnant until I was into my 2nd trimester (thanks to never having a period). Also, I found out that pregnancy symptoms aren’t necessarily the same if you also have an IUD.

Thankfully, the pregnancy went well, and I found a wonderful open-adoptive family for my son, who is now 3mos old. They waited 10 years to see their baby dreams come true, so my unexpected pregnancy turned into a win-win. :)
I would advise any woman with a Mirena to be cautious about pregnancy-testing if they lose their period with the Mirena. I just barely knew about my pregnancy in time to have been afforded the option for an abortion (if I had wanted one).

i am on my second copper IUD in 14 years – best thing that ever happened to me! hormonal birth control didn’t agree with me and condoms were frustrating (and not 100% effective) in my long-term monogamous relationship. the copper IUD works for me + i still have my period as regular as clockwork, which is fine. i recommend it unreservedly to any woman looking for a good contraceptive option (unless sleeping with new partners, in which case condoms are also necessary). so sad to hear that it’s so expensive in the US!

I lost 30% of my uterus because the wall was punctured. Might not be able to have kids because of it. If you dig into the statistical reliability of the non-hormonal IUD (one I had), they are less reliable than they seem. The statistics are reported on a different scale. My gyno that removed the rupture, who is the head of a hospital OBGYN unit, nearly refuses to insert the non-hormonal anymore because he has delivered too many babies with women who go it. He did not give me mine. I also know a lot of woman who have not had a problem with their IUD’s. I just wish I had the information I have now because I would have chosen the one with hormones. I was told there is no difference between IUD’s. I had it 6 months when it failed.

I’m the product of an IUD accidental conception. I’m fairly sure it was a copper IUD since the year was 1975. I tried the Mirena IUD and for me personally it was horrific in many ways, I will spare you the details. I am fairly sensitive YMMV. I paid 600 to have the dang thing inserted, I was very pissed at having it removed 6 months later and it took me 6 months to recover.

That really sucks. Definitely one of the reasons why IUDs need to be 100% covered. The pain of dealing with horrible complications doesn’t need to be compounded by watching $600 being lost in the process. :(

Thanks, and yeah…. Not to discourage anyone else. I have heard lots of positive stories from others about their experiences with IUD’s. Many people are great with them. I am very sensitive to hormonal changes. I can’t take birth control pills of any kind. They make me sick or nuts or a combination of both depending on the pill. So we continue on with our trusted, tried and true friend, Trojan.

I’ve been the proud, happy owner and operator of a Paragard copper IUD for over three years now. At the time of insertion, I was uninsured and underwent the procedure free of charge courtesy of Planned Parenthood. Please, please look into these family planning facilities if you’re in need. During the sizing of my uterus, my amazing nurse even made a point of telling me, “Gotta make sure it’ll fit! This is a $500 piece of equipment we’re installing!”

I can’t predict what your experience will be, but mine has been virtually painless. Insertion was uncomfortable, but the pain lasted no longer than two minutes and subsided immediately upon removal of the speculum. Occasionally, I’ll spot and cramp more in between periods than I had before, but my periods are no longer or heavier than they once were. I’d experienced nothing but trouble with other methods of contraception, from bacterial vaginosis to intense mood changes. Nothing like that with Paragard.

Viva la IUD! When you get yours, be sure to name it. I’ve dubbed mine John Constantine, because he’s my personal demon slayer.

I work in a pediatric gynecology clinic, and we are nuts about the Mirena IUD (Paragard is nice too, but makes periods worse, which teens rarely want.) Not only is it rilly rilly effective birth control, but it makes periods lighter and sometimes they go completely away. New research shows it is not only just fine for women who have never given birth, but it’s okay for teens with menstrual problems at any age (youngest I’ve seen is 11.) If someone is developmentally delayed, or too anxious to have it done in clinic, we can insert them when someone is sedated (after a conscious consent process, natch.)

Uterine perforation is a risk, but the risk decreases with the experience of the practitioner. The GYNs I work with have inserted literally hundreds of IUDs and never had a perforation. What’s more common is an IUD being expelled (the uterus contracts and pushes it out) and sometimes people don’t notice. Of course, there are no 100% effective methods of birth control (not even sterilization), so we always tell patients if they have symptoms of early pregnancy to go to their doctor and get tested. And use condoms to protect against STDs, of course.

Here’s what getting an IUD is like if you’ve never given birth:

You go to the GYN who takes some urine to make sure you’re not pregnant. She (or he) performs a basic pelvic exam to make sure all is in working order and also swabs for gonorrhea/ chlamydia (if you prescribe antibiotics when the results are back, it prevents the bacteria from proliferating in the uterus.) Then she puts 1-2 fingers in your vagina and presses on your abdomen to feel what direction your uterus tips in. It can be neutral, forwards, or backwards. That helps with “aiming” the IUD.

Then she numbs the cervix with lidocaine (sometimes, depends on the GYN). Then she puts a tenaculum, aka a clamp, on your cervix to hold it in place. She dilates your cervix with a plastic rod. Then she has to measure your uterus, which is often the most painful part, to see how deep the Mirena will go. The “sounder” has to touch the top of the uterus, which makes it cramp. Then she inserts the Mirena with a little inserty-plastic-tube thingie (the medical term) and you are done. She’ll trim the strings and tell you to come back for a check.

There are three painful points- dilation, measuring the uterus, and the Mirena insertion. If you can get a Vicodin/ Percocet and/ or Ativan it helps, but in the clinic we use mostly ibuprofen and the teens do fine.

For 1-6 months you’re in for some spotting and cramping which is worst the first day and gets progressively better. Then after 5 years you do it all over again (7 for the Paragard.)

If you’ve given birth before, you’ll barely notice it because your cervix is wider and stretchier.

Do not allow the IUD filaments (like a nylon line) to be trimmed back too far right away after placement. The IUD often settles a bit after placement–often higher up in the uterus. Too short = cervix fangs. Ouch. (Not to mention difficulty removing the IUD later on.) They can always be trimmed back later.

I have placed dozens of Mirenas and fewer Paragards (the copper one) over the last 10 years and most women are satisfied, although a few have had problems (cramping or unsatisfactory pattern or level of bleeding), but you cannot beat the efficacy. IUDs are definitely underutilized in the US–mostly because of bad PR, but I think that it is changing. My wife had one placed after each of our 4 kids (1 copper, then 3 successive Mirenas.)

Big fan of my copper IUD. Hormones from the pill (and I tried many) were messing me up. It is strange to consider that my alternative is to stick copper into my body (condoms aren’t enough IMO). But it works, and the side effects are thankfully manageable. Yes, heavier bleeding and a few cycles had some serious cramping. It’s not for everyone, and insertion is not pleasant. But I’d recommend it to any woman…but the price is definitely a deterrent b/c if it doesn’t work (rejection, severe side effects, etc) then that’s a lot of money to have spent, not to mention going through the procedure.

Best part was picking up the pill that is used to prepare the cervix and uterus for insertion. The pharmacists gave me the “BABY KILLER” look. B/c it’s one part of what’s used in a chemical abortion. So ladies, prepare to be judged by The Pharmacists Who Know All.

Seriously, fruck the judgement. If you only knew what those guys are doing when they go home at night. If they were good people, they wouldn’t be taking the time to throw stones. Seriously, fruck em’ all!

I have ParaGuard, because I always felt like hormones made me feel crazy. It was over$500.00 (with installation). The gyno that did the procedure encouraged me NOT to get it.. saying its an expensive upfront cost and was concerned about my not having had any children yet. But I had done my homework and I insisted. In hindsight, I should have found a different gyno. I think she probably didn’t know what she was doing because it hurt so terribly when she inserted it. I went white, saw stars.. thought I was going to vomit. My current gyno has apologized FOR her, saying it should have been a slightly uncomfortable procedure akin to a pap smear.

Knowing that the procedure should be painless, even for women who have no kids, I would wholeheartedly recommend it.

Anyone in the know have scientific references to the potential side effects of these devices? I am really curious what the effect of leeching copper and hormones into the bloodstream might be on a woman’s short term and long-term health, particularly given some of the negative reports from women here. Is it healthy to stop periods? They are there for a reason, so I should think not.